Pelvic Organ Prolapse

Treatment

Treatment varies depending on the type of prolapse. Most pelvic organ prolapse can be corrected only with surgery, but in many instances it may first be treated with nonsurgical options. Surgery may not be necessary for women who are not sexually active, are unable to undergo surgery because of medical reasons, or those who experience few or no symptoms.

Surgeons at at all three Mayo Clinic locations are using robot-assisted surgery for some women with pelvic organ prolapse, with or without a uterus in place. The Da Vinci robot allows the surgeon to make smaller abdominal incisions and can reduce hospitalization to an overnight stay.

Medications

Menopause results in lower estrogen levels, which weakens the muscles of the vagina. Estrogen replacement therapy (ERT) may strengthen these muscles; however, some patients with cancer and other conditions should not use ERT. This treatment is used for vaginal weakening and incontinence or along with other types of treatment for severe prolapse.

Physical Therapy

Electrical Stimulation

A device which delivers small electrical currents is applied to targeted muscles within the vagina or on the pelvic floor. The current causes muscles to contract, which strengthens them.

Biofeedback

As a patient does pelvic floor exercises, a sensor monitors muscular contractions to determine if the exercises affect the targeted muscles.

Surgery

One in 11 women requires surgery for pelvic organ prolapse in her lifetime. Most sexually active women who develop a vaginal prolapse choose surgery because it's an effective treatment. One-third of these patients will need additional surgeries to correct recurrent proplapses. It is more likely that a patient who needs surgery at a younger age may have repeated surgeries, because the affected tissue is usually defective or damaged. In addition, younger patients tend to be more active and put additional strain on their pelvic floor support.

If a woman develops symptoms of one type of vaginal prolapse, she is likely to have or develop other types as well. The typical strategy is to correct all prolapse-related problems at once.

Surgery, usually major surgery, is performed under general or regional anesthesia. Patients may be hospitalized for two to four days and are instructed to avoid heavy lifting for approximately six weeks. Another option is laparoscopic or minimally invasive surgical procedures. This surgical technique is becoming more common for treating a vaginal vault prolapse after a hysterectomy.

Surgeons have different strategies for various types of prolapse.

Prolapse of the Rectum (Rectocele)

Rectocele is corrected through the vagina. Typically, the surgeon makes an incision in the vaginal wall and then secures the connective tissue between the vagina and rectum to secure the organ in its proper position. Excess tissue is removed and the vaginal wall is closed.

Prolapse of the Bladder (Cystocele)

Cystocele is usually corrected through the vagina. Typically, the surgeon makes an incision in the vaginal wall and pushes the bladder up. The surgeon then secures the connective tissue between the bladder and vagina to secure the organ to its proper position. Excess tissue is removed and the vaginal wall is closed. If urinary incontinence is present, the urethra is supported with a procedure called a bladder neck suspension or a sling, in which material such as Teflon is used to close the urethral sphincter.

Prolapse of the Uterus (Uterine Descensus)

A common approach for this procedure is through the vagina. For women who are postmenopausal or do not want more children, prolapse of the uterus is usually corrected with a hysterectomy.

Vaginal Vault Prolapse and Herniated Small Bowel (Enterocele)

These defects often occur together high in the vagina, so surgery may be approached through the vagina or abdomen (for severe vaginal vault prolapse). This usually involves vaginal vault suspension, in which the surgeon attaches the vagina to the tailbone at the base of the spine.